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10.19 Bites


Presentation

Histories of animal bites are usually volunteered, but the history of a human bite, such as one obtained over the knuckle during a fight, is more likely to be denied or explained only after questioning. A single bite may contain various types of injury, including underlying fractures and tendon and nerve injuries, not all of which are immediately apparent.

What to do:

What not to do:

Discussion

Animal bites are often brought promptly to the ED, if only because of a legal requirement to report the bite, or because of fear of rabies. Bite wounds account for 1% of all ED visits in the US, most caused by dogs and cats. Most dig bites are from household pets rather than strays. A disproportionate number of dog bites are from German shepherds.

Bites occur most commonly among young, poorly supervised children who disturb the animals while they are sleeping or feeding, separate them during a fight, try to hug or kiss an unfamiliar animal or accidently frighten it. Malpractice claims and other civil lawsuits often follow bite injuries.

Dog and cat bites both show high rates of infection with staphylococcus and streptococcus species, as well as Pasteurella multocida and many different gram-negative and anaerobic bacteria. In addition to these organisms, 10-30% of all human bites are infected with Eikenella corrodens, which sometimes show resistance to the semisynthetic penicillins, but sensitivity to penicillin. Adequate debridement and irrigation are clearly more effective than prophylactic antibiotics, and except in wounds that are at high risk for developing infection are often all that is required to prevent infection of bites.

Less than 0.1% of all animal bites result in rabies. For questions of local rabies risk, local public health services may be available and valuable support as sources of information regarding the area's prevalence of rabies in an involved species.

References:


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